Developing Nurse Leaders

Although a small but growing number of programs now exist to prepare minority nurses for leadership roles in health care management, academia and health policy-making, very few–if any–have focused specifically on American Indian and Alaska Native nurses. But that is about to change with the arrival of Pathways to Leadership, an Indian Nurse Leadership curriculum that has been in development for several years.

The project began in June 1997, when a team of four Indian nurse leaders and one non-Indian nurse leader were selected to attend the Third Congress of Minority Nurses in Denver, which was sponsored by the Health Resources and Services Administration (HRSA), Bureau of Health Professions, Division of Nursing. From this conference, the plan to create a leadership development program tailored exclusively to the needs of Indian nurses emerged.

Initially, the proposed curriculum focused on generic leadership behaviors and skills that are not specific to Indian culture. However, the Indian team members identified the need to explore the concept of Indian nurse leadership further and to identify whether the dimensions of the Indian leadership style were different from those of general, mainstream leadership. To help define Indian nurse leadership, the National Alaska Native American Indian Nurses Association (NANAINA) was instrumental in supporting and encouraging the development of three Indian Nurse Leadership modules for the curriculum, along with a model showing the relationship of the different concepts examined in the modules.

As a result, the present Pathways curriculum consists of nine modules. Six of them focus on general nurse leadership topics:

  • Knowing Self
  • Personal and Professional Communication and Mentoring
  • Group Process
  • Decision-Making
  • Change Process
  • Being a Futurist.
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They are complemented by three culturally competent modules devoted to the following topics: Being a Leader in the Indian Way, Indian Nursing and Tribal Sovereignty, and Indian Nursing and Indian Health Programs.

The focus of the general leadership curriculum is on personal development of leadership. Native Americans value personal growth and self-actualization, so emphasizing a personal perspective of leadership is compatible with Indian culture and values. In addition, Indian concepts are interlaced appropriately within the generic leadership modules. The two worldviews are compared and contrasted. This provides the Indian nurse with a more bicultural view of Indian and non-Indian health care systems.

Filling a Knowledge Gap

Developing Nurse Leaders

One of our biggest challenges in developing the Indian-specific topics was that knowledge about the concept of Indian nurse leadership is almost nonexistent. A review of the literature revealed limited research in the area. To fill the void, we utilized several sources of information to help us develop the curriculum. These included interviews with Indian leaders, conferences on Indian leadership, historical information on Indian leaders, personal experiences of the team members, directors of Indian health programs, and focus groups with Indian nurses and non-Indian nurses who worked with Indian patients. We also explored the spiritual, traditional and ceremonial Indian ways of knowing.

Armed with these data and insights, we developed the Indian section of the Pathways curriculum. Module 7, Being a Leader in the Indian Way, identifies the facets of Indian nursing and the characteristics and actions of Indian nurse leaders. It presents and explores concepts of Indian nurse leadership such as spirituality, humility and self-actualization. Module 8 focuses on political issues relating to Indian tribes and nations, including tribal sovereignty, self-governance and the application of these concepts to Indian nurse leadership. It also examines the importance of being a spiritual leader.

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The last module, Indian Nursing and Indian Health Programs, explores Indian health issues, Indian health ethics and Indian tribal programs. Information from the generic leadership modules is interwoven with the Indian concepts to synergize the nine modules into a complete leadership training program suitable for developing the skills of current and future Native nurse leaders.

Putting All the Pieces in Place



In fall 2002 at the eighth annual NANAINA Summit in Oklahoma City, the Pathways team presented the proposed leadership curriculum to Indian and non-Indian nurses for their evaluation and recommendations. This peer review enabled us to identify gaps in the curriculum. It also helped us realize that we needed to have a framework to guide us in what the curriculum should include and how it should be taught.
To build this guiding framework, we again drew information from a variety of sources. We used data that had been gathered from focus groups of Indian nurse leaders several years earlier at NANAINA Summit IV. We also examined the models of Indian nursing developed by NANAINA members Roxanne Struthers, Sandy Littlejohn and John Lowe.1, 2  Their work provided a valuable starting point for creating our model framework.


The guiding framework for Pathways to Leadership–which encompasses both the Indian and generic leadership modules–is based on three themes:

  • Point of reference (being connected) for the Indian nurse leader. Connectedness for the leader focuses on the individual, the family and the tribal community.
  • What an Indian nurse is. Native nurses can be defined by such terms as: spiritual, self-actualized, visionary, quiet presence, humble, wise, experienced, political and recognized. 
  • What an Indian nurse leader does. This includes mentoring, serving as a role model, communicating, listening, mobilizing, inspiring and demonstrating values.
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Putting It into Practice

Now that the final stage of developing the Pathways to Leadership curriculum was finished, it was time to “take the show on the road.” In June 2003 the Pathways team organized a gathering for Indian nurse leaders in Phoenix, Ariz., to present the new leadership training curriculum. Two other nurses collaborated with us in implementing this event: the nurse consultant for the Phoenix area of the Indian Health Service, and the director of Arizona State University College of Nursing’s American Indian Students United for Nursing (ASUN) project.

Developing Nursing Leaders

Seventeen Indian nurses attended the weeklong gathering. We presented the curriculum modules over the week at the rate of two per day. Each day began with a prayer or meditation by an Indian elder, followed by opening circles in which all the participants sat together in a circle to share our thoughts and ideas. The Indian cultural tradition of the circle is important, because it means that we will come back to the beginning.


Several guest speakers were invited, to serve as examples of leadership and express their views of leadership in relation to the concepts discussed in the modules. For example, one former tribal chief described his three principles of leadership: “be honest to yourself,” “listen to people” and “respect their culture.” One of the Pathways team members served a meal at her home for all of the participants. At the end of the week, the gathering ended with a giveaway (a Cherokee tradition of expressing gratitude). We gave gifts to the participants to show our appreciation to them for attending and for letting us be their teachers. Finally, an ending circle was formed and the closing ceremony was conducted by an Apache healer.

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Participants were asked to evaluate the program daily, with a summary evaluation at the end of the gathering. This feedback revealed that the curriculum was well received by the students.

While we are proud of this initial success, at this point Pathways to Leadership is still an ongoing work in progress. The presentation in Phoenix was a pilot project that we hope will set the stage for nationwide implementation. Our goal is to continue to refine the curriculum for expanded use in schools of nursing and with nursing leaders of tribal health programs. 
For more information about the Pathways to Leadership project, please contact Lee Anne Nichols ([email protected]), Martha Baker ([email protected]) or Judy Goforth Parker ([email protected]).


  • Lowe, J. and Struthers, R. (2001). “Profession and Society: Conceptual Framework of Nursing in Native American Culture.” Journal of Nursing Scholarship, Vol. 3, No. 3.
  • Struthers, R. and Littlejohn, S. (1999). “The Essence of Native American Nursing.” Journal of Transcultural Nursing, Vol. 10, No. 2.
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